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Traction alopecia

Nonhlanhla P Khumalo, MBChB, FCDerm, PhD
Paradi Mirmirani, MD
Section Editor
Maria Hordinsky, MD
Deputy Editor
Abena O Ofori, MD


Traction alopecia is a form of hair loss that results from prolonged or repetitive tension on hair. Traction alopecia most commonly occurs along the frontal or temporal scalp, but can also occur in other sites of the scalp and in other hair-bearing areas (picture 1A-C).

Having a high clinical suspicion for traction alopecia in at-risk populations and obtaining a detailed history of current and past hair care practices is essential for making the diagnosis. Early recognition and cessation of the offending hair care practice is critical because sustained traction can lead to permanent hair loss.

The clinical features, diagnosis, and management of traction alopecia will be reviewed here. An overview of the evaluation of patients with hair loss is provided separately. (See "Evaluation and diagnosis of hair loss".)


Traction alopecia can occur when hair follicles are subjected to prolonged or repetitive tension. Although epidemiologic data on traction alopecia are limited [1-4], it appears that traction alopecia is most frequently diagnosed in females of African descent with Afro-textured hair. The relatively high prevalence in this population is most likely related to the frequent use of traction hairstyles (eg, braids or hair weaves) in this population. In support of this theory, traction alopecia occurs in other populations in association with the use of traction hairstyles, such as tight ponytails [5,6], chignon or bun hairstyles (as often worn by ballerinas) [7,8], hair extensions [9], hair pins (as for securing nursing caps) [10], and the Sikh practices of tightly twisting long hair on the scalp and knotting the beard hair [11,12].

Differences in exposure to traction hairstyles likely contributes to the higher prevalence of traction alopecia in females compared with males and adults compared with children in populations of African descent. In a study of 874 adults in South Africa, traction alopecia was detected in 32 percent of women compared with only 2 percent of men [1]. Increasing prevalence with age was demonstrated in a study of 1042 schoolchildren (ages 6 to 21 years) in South Africa; traction alopecia was present in 9 percent in girls in their first year of school (age 6 to 7 years) compared with 22 percent in girls in their last year of high school (age 17 to 21 years) [2]. No male schoolchildren had traction alopecia. Traction alopecia can also occur in infants. A case report documents traction folliculitis (an early presentation of traction alopecia) in an eight-month-old child [13].

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Literature review current through: Oct 2017. | This topic last updated: May 13, 2016.
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